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Systemic Anti-Cancer Therapy Regimen Library

Home > LUNG SCLC Extensive - cARBOplatin, etoposide and aTEZOLIzumab

LUNG SCLC Extensive - cARBOplatin, etoposide and aTEZOLIzumab

Treatment Overview

Usually 4 cycles of cARBOplatin, etoposide and aTEZOLIzumab.

Continue aTEZOLIzumab monotherapy until disease progression or toxicity.

Cycles 1 to 4 - 21 days - cARBOplatin, etoposide and aTEZOLIzumab

Cycle length:
21

aTEZOLIzumab, subsequent doses: Administer appropriate premedications if patient had a previous infusion-related reaction of a grade where re-challenge is possible.

Cycle 5 (and all further cycles) - 21 days - aTEZOLIzumab continuation

Cycle length:
21

aTEZOLIzumab:

  • An alternative dosing schedule is 1680 mg on day 1 of a 28-day cycle.
  • Administer appropriate premedications if patient had a previous infusion-related reaction of a grade where re-challenge is possible.

Cycle details

Cycles 1 to 4 - 21 days - cARBOplatin, etoposide and aTEZOLIzumab

Medication Dose Route Days Max Duration
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
dexamethasone * 8 mg oral administration 1, 2, 3
ondansetron 8 mg oral administration 1
aTEZOLIzumab 1200 mg intravenous 1 60 minutes
cARBOplatin * 5 AUC (area under the curve) intravenous 1 60 minutes
etoposide (as phosphate) 100 mg/m² intravenous 1, 2, 3 60 minutes
ondansetron 8 mg oral administration 1
domperidone 10 mg Three times daily oral administration 1

aTEZOLIzumab, subsequent doses: Administer appropriate premedications if patient had a previous infusion-related reaction of a grade where re-challenge is possible.

Cycle 5 (and all further cycles) - 21 days - aTEZOLIzumab continuation

Medication Dose Route Days Max Duration
aTEZOLIzumab 1200 mg intravenous 1 60 minutes

aTEZOLIzumab:

  • An alternative dosing schedule is 1680 mg on day 1 of a 28-day cycle.
  • Administer appropriate premedications if patient had a previous infusion-related reaction of a grade where re-challenge is possible.

Full details

Cycles 1 to 4 - 21 days - cARBOplatin, etoposide and aTEZOLIzumab

Day: 1

Medication Dose Route Max duration Details
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
aTEZOLIzumab 1200 mg intravenous 60 minutes
Instructions:
  • If the initial dose is well tolerated, subsequent doses may be administered over 30 minutes.
  • Administer appropriate premedications if patient had a previous infusion-related reaction of a grade where re-challenge is possible.
cARBOplatin * 5 AUC (area under the curve) intravenous 60 minutes
Instructions:
Hypersensitivity risk increases with number of cycles of cARBOplatin.
etoposide (as phosphate) 100 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 2

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • Dose and duration may be individualised at clinician’s discretion.
etoposide (as phosphate) 100 mg/m² intravenous 60 minutes

Day: 3

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • Dose and duration may be individualised at clinician’s discretion.
etoposide (as phosphate) 100 mg/m² intravenous 60 minutes

Cycle 5 (and all further cycles) - 21 days - aTEZOLIzumab continuation

Day: 1

Medication Dose Route Max duration Details
aTEZOLIzumab 1200 mg intravenous 60 minutes
Instructions:
  • If the initial dose is well tolerated, subsequent doses may be administered over 30 minutes.
  • Administer appropriate premedications if patient had a previous infusion-related reaction of a grade where re-challenge is possible.

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not recommended

Emetogenicity:

  • HIGH (cARBOplatin AUC≥4) cycles 1 to 4;
  • MINIMAL aTEZOLIzumab alone.

References

Morrissey, K. M., M. Marchand, H. Patel, et al. 2019. "Alternative dosing regimens for atezolizumab: an example of model-informed drug development in the postmarketing setting." Cancer Chemother Pharmacol 84(6):1257-1267., PMID: 31542806

Horn, L., A. S. Mansfield, A. Szczesna, et al. 2018. "First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer." N Engl J Med 379(23):2220-2229., PMID: 30280641

Paz-Ares, L., M. Dvorkin, Y. Chen, et al. 2019. "Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial." Lancet 394(10212):1929-1939., PMID: 31590988

Rudin, C. M., M. M. Awad, A. Navarro, et al. 2020. "Pembrolizumab or Placebo Plus Etoposide and Platinum as First-Line Therapy for Extensive-Stage Small-Cell Lung Cancer: Randomized, Double-Blind, Phase III KEYNOTE-604 Study." J Clin Oncol:JCO2000793., PMID: 32468956

Liu, S. V., M. Reck, A. S. Mansfield, et al. 2021. "Updated Overall Survival and PD-L1 Subgroup Analysis of Patients With Extensive-Stage Small-Cell Lung Cancer Treated With Atezolizumab, Carboplatin, and Etoposide (IMpower133)." Journal of Clinical Oncology 39(6):619-630., PMID: 33439693

Castells, M.C., Matulonis, U.A., and Horton, TM. Infusion reactions to systemic chemotherapy. Savarese DMF and Feldweg AM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed 26 March 2021).

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641., PMID: 25089112

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.